title: Effects of pancrelipase on nonalcoholic fatty liver disease after pancreaticoduodenectomy.
abstract: BACKGROUND
  Postoperative nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has recently become recognized. However, the pathoetiology of postoperative NAFLD is largely unknown. Furthermore, the optimal treatment has not been established. The aim of this prospective study was to clarify whether pancrelipase, which contains digestive pancreatic enzymes, could reverse NAFLD.
  
  
  METHODS
  A collaborative clinical trial has been conducted (UMIN000006841). A total of 30 patients who developed NAFLD after PD were prospectively treated with pancrelipase. NAFLD was defined and evaluated by the liver-to-spleen attenuation ratio on computed tomography (CT). Clinical symptoms and laboratory findings were also assessed.
  
  
  RESULTS
  The mean liver-to-spleen CT ratio before surgery in 30 patients was 1.233. It declined to 0.453 at diagnosis of NAFLD. It was significantly improved by the treatment and the CT ratios at 1, 3 and 6 months after treatment were 0.762, 0.958 and 0.904, respectively (vs. pretreatment, P < 0.001). The mild liver dysfunction was also improved. Total protein, albumin and total cholesterol levels were significantly improved by the treatment. Importantly, relatively severe diarrhea seen in 11 patients was also ameliorated.
  
  
  CONCLUSIONS
  Pancrelipase has a significant beneficial impact on NAFLD after PD. Maldigestion after pancreatic surgery may be a main cause for the development of postoperative NAFLD.
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Nagai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sho
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Akahori
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirooka
authors.forename: So
authors.initials: S
authors.lastname: Yamaki
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishiwada
authors.forename: Naoya
authors.initials: N
authors.lastname: Ikeda
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009752:Nutritional Status; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D020799:Pancrelipase / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D005765:Gastrointestinal Agents; D020799:Pancrelipase
keywords: Complication; Maldigestion; NAFLD; Pancreaticoduodenectomy; Pancrelipase